- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $1,698.24 / $7,762.47
| Facility | | $50.12 | $1,698.24 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $109.65 / $234.42
| Professional | | $43.65 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $288.40 / $977.24
| Professional | | $50.12 | $288.40 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $117.49 / $204.17
| Professional | | $47.86 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $288.40
| Professional | | $114.82 | $144.54 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,548.82
| Facility | | $213.80 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $95.50 / $245.47
| Professional | | $43.65 | $95.50 | $245.47 |